BCI devices and their capacity to express human will having legal value: A model of risk-based classification

One of the ultimate frontiers in biotechnology is Brain-computer-interface. BCI devices are currently developed for therapeutic purposes (e.g., as assistive tools) but also recreational ones. A BCI system detects brain activity, allowing a decoding of patterns of neural signals, then ‘translatable’ in commands a computer can understand and even carry out in the external reality. That’s why BCI is now becoming more used (or experimented), considering the advantages that could derive from it. Nevertheless, it also raises some questions from a legal perspective. This Paper focuses on BCI-based devices used for assistive and augmented communication of users, and wonders what legal regime should be accorded to the personal will expressed through those tools. Once the risks have been identified, the parameters and requirements a BCI device must meet, for the human will expressed through it having legal value, are outlined. The Paper proposes, in conclusion, a self-assessment strategy to operationalize BCI technologies applicable to the context of legal relations, implementing methods of risk evaluation and management. A risk- based classification model is also suggested

The Possible Relationship Between Law and Ethics in the Context of Artificial Intelligence Regulation

The latest academic discussion has focused on the potential and risks associated with technological systems. In this perspective, defining a set of legal rules could be the priority but this action appears extremely difficult at the European level and, therefore, in the last years, a set of ethical principles contained in many different documents has been published. The need to develop trustworthy and human-centric AI technologies is accomplished by creating these two types of rule sets: legal and ethical. The paper aims to critically analyse and compare these rule sets in order to understand their possible relationships in the regulation of legal problems, not only theoretically but also, where present, in some practical applications of AI, such as self-driving cars, smart toys, smart contracts and legal design. Indeed, the purpose is to identify how legal rules and ethical principles can interact for adequate regulation of AI, with particular regard to the fields of application that will be analysed

Open vascular surgery training in the endovascular era: 5-year experience with cadaver laboratory

Background: Vascular cadaver laboratory (CAD LAB) courses included vascular exposure techniques and simulations of open procedures. Aim of the study was to demonstrate the benefit of cadaver laboratory (CAD LAB) courses to improve trainees' experience in open surgical vascular procedures. Methods: Between 2014 and 2020, 162 vascular surgeons or medical trainees (mean age 28 years) participated in vascular CAD LAB courses in Italy and France. Outcomes were measured using the Linkert survey, performed pre- and post-course to evaluate self-efficacy/confidence, surgical experience and resident perception of the course with a range score from 0 to 5 for each point. Anatomical knowledge improvement was measured using a questionnaire with multiple answers pre- and post-course. The course was considered to have yielded a positive result if the post-course Linkert survey score increased by ≥2 points, or in the case of an increase of at least 30% above the baseline value of the multiple questionnaires. Results: Post-course questionnaires were positive for all outcomes evaluated. Participants' perception of the usefulness of the CAD LAB evaluation was 4.8 out of 5. For the vascular CAD LAB, participant anatomical knowledge improved overall from an average of 55% to 93% (P < .001), and self-efficacy/confidence improved from 2.3 to 4.5 out of 5 (P < .001). Regarding the different operative procedures, the greatest self-efficacy/confidence improvement was recorded in carotid endarterectomy and aortic procedures (+50% and +66% respectively; P < .001). The city location (Italy vs. France) did not affect the results. Conclusions: CAD LAB courses were shown to be effective in increasing participants' self-efficacy, confidence, and anatomical knowledge in open vascular surgical procedures

Urgent endovascular revascularization in acute on chronic critical limb ischemia

Background: The aim of this study was to evaluate early and one-year outcomes of urgent endovascular treatment in patients with acute on chronic critical limb ischemia (CLI). Methods: Between January 2012 and December 2013 104 patients with acute on chronic CLI (Rutherford class 4-6) were referred to two tertiary hospitals. In all cases the urgent endovascular revascularization was considered the first therapeutic option. Twenty-seven patients (26%) were excluded from this approach (long occlusion &gt;30 cm of the femoro-popliteal tract and/or massive gangrene with abscess/osteomyelitis/necrotizing fasciitis). Results: Seventy-seven out of 104 patients received an urgent endovascular treatment. They were predominantly male (43, 55.8%) with a mean age of 76.5 years (range 47-94). In 67 cases (87%) the patients had leg/foot lesions (54, 70.1%, Rutherford class 5, and 13, 16.9%, Rutherford class 6). During the follow-up (mean duration 6.2 months, range 1-24 months) the healing of the lesions and the relief of rest pain were obtained in 46 cases (59.7%). Estimated one-year primary patency, primary assisted patency, secondary patency, and limb salvage rates were 63.6%, 68.3, 69%, and 84.1%, respectively. At uni- and multivariate analysis patients in Rutherford class 6 showed poor results in terms of primary patency, primary assisted patency, secondary patency, and limb salvage (P&lt;0.001). Conclusions: Urgent endovascular treatment in selected patients with acute on chronic CLI represents a safe and effective option with good results in terms of healing of the ischemic lesions, relief of rest pain, and limb salvage. Patients in Rutherford class 6 showed fewer benefits with this approach

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein

Defence mechanisms and attachment styles in paranoid ideation evaluated in a sample of non-clinical young adults

Objective. The aim of this investigation was to evaluate defence mechanisms and attachment styles in paranoid ideation through a cross-sectional design with sequential recruitment of subjects. Methods. Five hundred and fifty non-clinical subjects were recruited from university students. A psychometric protocol comprising paranoid ideation scale of Symptoms Check List (SCL-90-R-Par) to identify paranoid ideation, Defence Style Questionnaire (DSQ-40) to evaluate defence mechanisms, and Relationship Questionnaire (RQ) to measure attachment styles was then administered. Results.We found a significant predictive value of immature defence mechanisms (®=0.48; p<0.0001) and preoccupied attachment style (®=0.25; p<0.0001) in the paranoid ideation. Moreover, subjects reporting a preoccupied or fearful attachment style showed higher levels of paranoia. Conclusions. This study revealed that paranoid ideation is mainly characterised by immature defence mechanisms. A clear insecure attachment style associated with paranoia was also found. The assessment of paranoid ideation should therefore consider the role of attachment style and defence mechanisms as an integral part during the diagnostic and therapeutic processes